Exam 4 - Lecture 4 Flashcards
1
Q
In an aqueous solution with a strong acid (HA), what happens to the acid?
A
In an aqueous solution with a strong acid (HA), the acid will fall off and become H+ and A-.
2
Q
In an aqueous solution with a weak acid, what is less likely to happen?
A
If we have a weak acid, the proton is less likely to fall off the acid.
3
Q
What kind of conjugate base results from a strong acid?
A
A strong acid will likely donate a proton, resulting in a weak base as the conjugate base.
4
Q
What kind of conjugate base results from a weak acid?
A
Weak acids are less likely to donate protons, so their conjugate bases are likely to be strong.
5
Q
How can a base (HB) dissociate?
A
HB can dissociate into H+ and B-.
6
Q
What does the base (B-) do when it combines with H+?
A
B- is the base, and combines with H+ and becomes HB.
7
Q
If a base is strong, what does it want to do regarding protons?
A
If a strong base, then it WANTS to hang onto protons.
8
Q
If a base is weak, what will it do?
A
If it’s weak, it will dissociate.
9
Q
If we have a strong base that wants to hang onto protons, what is the likely characteristic of the conjugate acid (HB) formed?
A
If we have a strong base, it wants to hang on to this proton, so the conjugate acid formed (HB) is probably a relatively weak conjugate acid as it doesn’t want to donate the protons it holds.
10
Q
If we have a weak base (B-) that is less likely to bond with a proton, what is the likely characteristic of any conjugate acid formed (HB)?
A
If we have a weak base (B-), then it’s less likely to bond with a proton. If it doesn’t really want to combine with a proton, then any conjugate acid that is formed is probably going to be a STRONG CONJUGATE ACID.
11
Q
How does the relationship between acid/conjugate base and base/conjugate acid work?
A
The relationship between acid/conjugate base and base/conjugate acid works in both directions.
12
Q
What reaction represents how a buffer interacts with H+?
A
Buffer + H+ ⇌ H buffer.
13
Q
What capability do buffers have regarding problems going either direction?
A
Buffers are able to correct problems going either direction.
14
Q
In a solution with a buffer, what forms are present?
A
In solution, we will have raw buffer floating around that is ionized and capable of binding with a proton. We’ll also have the H buffer form.
15
Q
If protons are taken away from the system, how does the buffer system respond?
A
If we take away protons from the system, this would allow H buffer to release protons, which will then even out the change in pH that would occur.
16
Q
If protons are added to the system, how does the buffer system respond?
A
If we add protons, we will probably have a decent amount of ionized buffer capable of binding with these protons, keeping them from being free in solution and thus lowering their acidic activity.
17
Q
What happens to the activity of protons when they are bound by a buffer?
A
When protons are bound, they don’t count as free protons and their activity is low.
18
Q
What are the three main buffers to focus on?
A
Focus on bicarb, proteins, and phosphate as buffers.
19
Q
Which buffer is most important inside cells?
A
Proteins are the most important inside cells.
20
Q
Which buffers are most important in the blood?
A
Bicarbonate, proteins, and phosphate are most important in the blood.
21
Q
How does the kidney buffer urine?
A
The kidney uses ammonia and basic compounds to buffer urine.
22
Q
Why does the kidney buffer urine?
A
This helps prevent urine from having a very low pH.
23
Q
What does the pK of a buffer represent?
A
pK of a buffer is basically equal to pH of equal quantities of its non-ionized and ionized components.
24
Q
When is a buffer best at buffering?
A
It’s best at buffering right around its pK value.
25
What is the pK of bicarb as a buffer?
pK of bicarb as a buffer is 6.1.
26
Technically, when should Bicarb be the most effective buffer based on its pK?
Technically, Bicarb should be probably the most effective buffer when pH of system is right around 6.1.
27
What is normal plasma pH?
Our plasma pH is 7.4.
28
Is bicarb most effective at normal plasma pH based on its pK?
No, bicarb is not most effective at normal pH based on pK.
29
Despite not being most effective at normal pH, how effective is bicarb, especially in preventing acidosis?
Despite not being most effective at normal pH, bicarb is still extremely effective, particularly at preventing acidosis.
30
What is the isohydric principle?
Isohydric principle means that all buffers are working together at same time.
31
Why are the other buffers less effective if you lose one buffer?
This is why if you lose one buffer, the others are less effective.
32
Are the pKs the same for each buffer?
All pKs are different for each buffer.
33
How does the combined activity of buffers compare to their individual activities?
They all work together and combined activity is better and more effective than any of their individual activities.
34
What pool do all buffers basically work on or with?
They all basically work on or with the same pool of protons that's available to the other buffers.
35
What does the normal buffer line represent?
Normal buffer line represents the blood buffering system, which is a combination of bicarb, proteins, and phosphate for the most part.
36
What is important about having a normal amount of proteins in managing system stress?
Having a normal amount of proteins is super, super important at managing stress to the system.
37
Which protein is a super important buffering protein, and why?
Hemoglobin in red blood cells is a super important buffering protein due to its high concentration compared to albumin.
38
How does hemoglobin buffer CO2?
Hemoglobin buffers CO2 not only in plasma but also within RBCs.
39
What are albumin's main functions regarding buffering and fluid?
Albumin has proton buffering abilities but is more important with regard to osmotic pressure and keeping fluid in the cardiovascular system.
40
What happens to the buffer line when Hb in blood is reduced?
When we reduce Hb in blood, the line flattens out and there is less effective buffering.
41
What happens to the buffer line when Hb is increased?
An increase in Hb makes the line steeper and indicates better buffering capacity.
42
What corresponds to CO2 levels (PCO2) on a buffer line graph?
Isobars correspond to CO2 levels (PCO2).
43
What effect does a steeper buffer line slope (due to more proteins/Hb) have on the isobars?
A steeper buffer line slope (due to more proteins/Hb) causes the isobars to get closer together and closer to the normal point on the graph.
44
What does a steeper buffer line slope mean in terms of bicarb change for a given pH change?
What it means is a greater amount in change of bicarb for a given change in pH.
45
How does the system swinging out a lot of bicarb as pH goes down affect the buffer line slope?
If the system can spit out a lot of bicarb as pH goes down, that changes the slope of the line.
46
How does the body swinging bicarb levels (removing bicarb) faster or more when becoming alkalotic and taking protons out affect the pH change?
If we have a system where we are becoming more alkalotic and taking protons out, if the body has a way of swinging bicarb levels (removing bicarb when alkalotic) faster or more, the system will experience less pH change.
47
How does larger variability in bicarb help block pH changes and what does it indicate about buffering?
This larger variability in bicarb helps block pH changes, indicating better buffering.
48
What effect does a flatter (more horizontal) buffer line slope (due to less proteins/Hb) have on the isobars?
A flatter (more horizontal) buffer line slope (due to less proteins/Hb) causes the isobars to get further apart from each other and further from the normal point.
49
Why does a flatter buffer line slope cause the isobars to get further apart?
This happens because there is less change in bicarb for a given change in pH.
50
How does a poorer buffer system cope with pH changes if it cannot effectively add or remove bicarb?
A poorer buffer system is not able to cope with pH changes as well if it cannot effectively add or remove bicarb from solution.
51
For a given PCO2 change, what pH change would be expected under conditions of a flatter buffer line?
For a given PCO2 change, we would expect to see a greater pH change under these conditions.
52
What are the isobars attached to?
The isobars are attached to the buffer line.
53
What is a nomogram used for?
A Nomogram looks like a fan and can be used to figure out the cause of the acid-base problem and potential treatment.
54
What is acute respiratory acidosis?
Acute respiratory acidosis occurs rapidly, and kidneys haven't compensated.
55
What leads to increased PCO2 and reduced pH in acute respiratory acidosis?
Reduction in ventilatory drive leads to increased PCO2 and reduced pH.
56
In aqueous solution, what can excess CO2 form?
In aqueous solution, excess CO2 has the capability of combining with water to form a proton and a bicarb.
57
In acute respiratory acidosis (excess CO2), why does pH lower?
Because bicarb is a weak base, not all formed bicarb will combine with the simultaneously formed protons, leaving excess protons which lowers pH.
58
What happens to bicarb levels in the blood as a result of having too much CO2 around?
There is a little bit of an excess of bicarb in the blood as a result of having too much CO2 around.
59
What is acute respiratory alkalosis?
Acute respiratory alkalosis happens when people are breathing too much.
60
What happens to CO2 levels and pH when someone is breathing too much?
Breathing too much leads to a deficit of CO2 and higher pH.
61
Why does pH rise in acute respiratory alkalosis?
pH is going to rise because of the reduction in protons.
62
What happens to plasma bicarb levels in acute respiratory alkalosis?
There is a lower plasma bicarb level because we don't have as much CO2 as normal.
63
What is seen with pH in chronic respiratory acidosis compared to acute?
In chronic respiratory acidosis, the pH looks a lot better (blunted).
64
How is chronic respiratory acidosis compensated?
It is compensated by the kidneys.
65
How effective is kidney compensation as a long-term regulator?
Kidneys are a very effective long term regulator, but not perfect.
66
What is a gain in a control system?
A gain in the control system is how much of a problem it can correct.
67
What is the significant increase in bicarb seen with chronic respiratory acidosis?
There is a large increase in bicarb due to kidneys.
68
What is seen with pH in chronic respiratory alkalosis compared to acute?
In chronic respiratory alkalosis, the pH is also blunted.
69
What happens to bicarb levels in chronic respiratory alkalosis?
There is a low amount of bicarb.
70
How do kidneys retain protons to help with pH problems?
Kidneys retain protons by turning off proton secretion systems to help the pH problem.
71
What happens to bicarb levels in chronic respiratory alkalosis?
There is a low amount of bicarb. There is a more significant reduction in arterial bicarb due to lower PCO2 and kidney action.
72
How can the kidney get rid of a lot of bicarb from circulation?
The kidney can also get rid of a lot of the bicarb from the circulation by choosing not to reabsorb filtered bicarb.
73
How quickly can the lungs correct a pH issue?
Lungs can correct pH issue very rapidly. Textbooks say within 3 minutes, but Schmidt says it can happen faster than that, almost instantaneously.
74
Which system provides the rapid fix for pH issues?
The lungs (and controllers of ventilation in brainstem) provide the rapid fix.
75
Which system provides the long-term fix for pH issues?
The kidneys are the long term fix.
76
How long does it take for kidneys to have an effect on pH?
It takes a while for kidneys to have an effect.
77
What causes metabolic acidosis?
Metabolic acidosis is caused by a lack of bicarb, producing too much acid, or consuming acids.
78
How do the lungs respond to metabolic acidosis?
The lungs increase ventilation (hyperventilate). The system's response is to increase ventilation.
79
What happens to PCO2 in response to metabolic acidosis?
There is low PCO2.
80
How does the respiratory system attempt to fix metabolic acidosis?
The respiratory system attempts to fix this rapidly.
81
What causes metabolic alkalosis?
Metabolic alkalosis is caused by way too much bicarb, or decreased acid production.
82
How does the respiratory system respond to metabolic alkalosis?
The respiratory system will slow down breathing (hypoventilate) to retain CO2.
83
What happens to PCO2 in response to metabolic alkalosis?
There is higher PCO2.
84
What limits the respiratory system's ability to compensate for metabolic alkalosis?
The respiratory system's ability to compensate for metabolic alkalosis is limited because ventilation can only be reduced so much before causing hypoxemia.
85
What is important to find when dealing with acid-base problems?
It is important to find the cause of the acid/base problem and what treatment might consist of.
86
In uncompensated respiratory acidosis/alkalosis, what happens to bicarb as a result of a significant PCO2 change?
Uncompensated respiratory acidosis/alkalosis both have a smaller increase or decrease in bicarb as a result of a significant change in PCO2 levels.
87
What is seen in uncompensated metabolic acidosis theoretically?
Uncompensated metabolic acidosis shows low pH and bicarb, and nothing for PCO2.
88
Does theoretically uncompensated metabolic acidosis happen in practice?
This really doesn't happen in practice as lungs compensate very rapidly if capable.
89
What is seen in uncompensated metabolic alkalosis theoretically?
Uncompensated metabolic alkalosis shows high pH and high bicarb, and nothing for PCO2.
90
What is seen with pH in partially compensated states compared to uncompensated?
Partially compensated everything shows the pH change is significantly less severe than in the uncompensated state.
91
What compensatory changes are seen in partially compensated states?
There is a compensatory change: increase in bicarb for respiratory acidosis; decrease in bicarb for respiratory alkalosis; decrease in PCO2 for metabolic acidosis; increase in PCO2 for metabolic alkalosis.
92
Is alkalosis compensation limited compared to acidosis compensation by the respiratory system?
Yes, alkalosis is limited because you can only reduce CO2 so much, so it's harder to fix.
93
What are the potential consequences of combined respiratory and metabolic problems?
Combined problems (respiratory and metabolic issues simultaneously) can be very serious.
94
What are causes of respiratory alkalosis?
Causes of respiratory alkalosis include respiratory system in overdrive, seizures, extreme anxiety, tumors, acute asthma exacerbation, congenital hyperventilation syndromes, inflammation of meninges or the brain itself, increases neural activity in brain, salicylates, progesterone, other hormones, high altitude, and over ventilation with mechanical ventilation.
95
Why can acute asthma exacerbation cause respiratory alkalosis?
Sometimes people experiencing a bad asthma attack can hyperventilate, even if they feel like they can't get air in.
96
How can salicylates (aspirin) cause respiratory alkalosis?
Some people are sensitive to aspirin and it causes them to have respiratory alkalosis.
97
How do hormones like progesterone increase respiratory drive?
Hormones interact with brainstem and increase respiratory drive.
98
Why can high altitude cause hyperventilation and potentially respiratory alkalosis?
High altitude causes hyperventilation due to decreased PO2 in the air.
99
Is respiratory alkalosis more or less common than acidosis?
Much less common than acidosis.
100
Why might respiratory alkalosis not be seen much in the OR?
It's most commonly psychological or neurological conditions of hyperactivation of the nervous system.
101
What are the general causes of metabolic acidosis?
Metabolic acidosis can be caused by losing bicarb, producing too much acid within the body, or consuming acids.
102
What drugs or toxic substances can cause metabolic acidosis?
Drugs or toxic substances causing metabolic acidosis include Methanol, Ethanol, Aspirin (salicylates), Ethylene glycol, and Ammonium Chloride.
103
What is methanol a byproduct of, and what is a potential severe effect of consuming it?
Methanol is a byproduct of fermentation, like drinking moonshine that hasn't been refined right. It's the reason that makes you go BLIND.
104
How can methanol and ethanol stimulate the pancreas and potentially lead to metabolic acidosis?
Methanol and ETHANOL both typically stimulate the pancreas. If the pancreas is overstimulated, it will produce more bicarb.
105
Can consuming alcohols cause acidosis?
Yes, many alcohols can be the equivalent of acids, and consuming lots of them can make you acidotic.
106
Where else can salicylates (aspirin) be found besides pills?
Aspirin (salicylates) are found in skin cleaners too such as acne meds which is a weak acid solution.
107
What compound is ethylene glycol a component of?
Ethylene glycol is a component of anti-freeze.
108
What colors might ethylene glycol leaks be, depending on the car?
Typically blue or green in color, leaks from radiator.
109
Does ethylene glycol smell sweet?
Yes, it smells sweet.
110
Is a little bit of ethylene glycol too much to consume?
Yes, very little is too much to consume, you don't want to consume it.
111
What compound is ammonium chloride usually a component of, and at what dose can it cause metabolic acidosis?
Ammonium Chloride is usually a component of fertilizer, and can cause metabolic acidosis at high doses.
112
What are causes of loss of bicarb ions leading to metabolic acidosis?
Causes include Increased pancreas activity or Pancreatic fistula, and Diarrhea.
113
How can increased pancreas activity or a pancreatic fistula cause loss of bicarb?
If you have a fistula, you can have multiple ducts and then you lose more.
114
What is a common cause of metabolic acidosis with a normal anion gap?
Diarrhea is a common cause of metabolic acidosis with a normal anion gap.
115
How does diarrhea cause metabolic acidosis?
Diarrhea causes loss of bicarb via feces.
116
Is loss of bicarb and diarrhea generally severe in adults?
Loss of bicarb and diarrhea are generally not severe in adults.
117
Why can loss of bicarb and diarrhea be dangerous in children?
It can be dangerous in children who have less ability to manage these changes due to not a fully developed kidney.
118
Is Renal tubular acidosis necessarily related to a sick kidney?
No, Renal tubular acidosis is not necessarily related to a sick kidney, but can result from acidosis.
119
Is Renal tubular acidosis a cause of metabolic acidosis with a normal or increased anion gap?
Renal tubular acidosis is a cause of metabolic acidosis with a normal anion gap.
120
What happens if kidneys aren't producing new bicarb?
Kidneys are in charge of producing new bicarb, so if they aren't, you're cooked.
121
What effect does renal insufficiency have on the anion gap, and why?
Renal insufficiency leads to an increased anion gap due to the kidneys' inability to maintain charge balance.
122
What is the result of kidneys being unable to produce new bicarb?
If the kidneys cannot produce new bicarb, the result is metabolic acidosis.
123
What else is impaired in renal insufficiency, leading to acidosis?
Proton removal via the kidney is also impaired, causing protons to build up, resulting in acidosis.
124
What is the most efficient way to produce ATP?
The most efficient way to produce ATP is oxidative metabolism.
125
What does oxidative metabolism bypass a lot of?
Oxidative metabolism bypasses a lot of lactate production.
126
Under ideal conditions, how many ATP are produced per molecule of glucose via oxidative metabolism?
38 ATP produced per molecule of glucose under ideal conditions.
127
When does lactic acidosis occur?
Lactic acidosis occurs when oxygen is deficient or normal means of ATP production aren't working.
128
What is hypoxemia?
Hypoxemia is a generalized reduction in oxygen in the blood.
129
What process can cells switch to when oxygen is deficient?
Cells can switch to glycolytic metabolism when you don't have oxygen.
130
How many net ATP are produced under hypoxemic conditions via glycolysis?
Only produce 2 ATP net under hypoxemic conditions.
131
What is produced as a byproduct of glycolysis when oxygen is absent?
Glycolysis produces lots of lactic acid as a byproduct when oxygen is absent.
132
What conditions related to oxygen transport can lead to lactic acidosis?
Anemia and Carbon monoxide can lead to lactic acidosis.
133
How does carbon monoxide affect hemoglobin and oxygen delivery?
Only takes 1 CO to bind to 1 of 4 Hb binding sites to make that hemoglobin inoperable and not release O2 into tissues.
134
What forms of shock can lead to lactic acidosis?
Shock (all forms: hypovolemia, cardiogenic, septic shock) can lead to lactic acidosis.
135
Why does shock lead to lactic acidosis?
If you don't have adequate volume/pressure, you won't deliver oxygen to tissues.
136
Is lactate a volatile or non-volatile acid?
Lactate is a non-volatile acid.
137
Which system(s) can compensate for non-volatile acids?
Non-volatile acids are harder for the lungs to handle. Lungs can't compensate easily for these, only kidneys primarily.
138
What effect does lactic acid typically have on the anion gap?
Lactic acid typically results in an increased anion gap.
139
What type of exercise can cause lactic acidosis?
Severe exercise. If muscles are stressed, overworked, or unconditioned.
140
How can ARDS lead to lactic acidosis?
ARDS is a problem bringing oxygen on board.
141
What conditions can cause ketoacidosis?
Ketoacidosis can be caused by Diabetes, Alcoholism, and Starvation.
142
How does uncontrolled diabetes cause ketoacidosis?
Uncontrolled diabetes causes problem delivering energy (glucose) to cells.
143
How does long-term alcoholism cause ketoacidosis?
Long-term alcohol exposure inhibits liver's ability to participate in blood sugar regulation.
144
Why does starvation cause metabolic acidosis/ketoacidosis?
Starvation causes the body to scramble for energy, resulting in metabolic acidosis.
145
Are ketone acids volatile or non-volatile?
Ketone acids (ketones) are non-volatile acids.
146
What effect do ketone acids typically have on the anion gap?
Ketone acids typically result in an increased anion gap.
147
Which specific ketone acid was mentioned as a primary issue with uncontrolled diabetes?
Acetoacetic acid was the one stated as a primary issue with uncontrolled diabetes.
148
Is metabolic alkalosis more or less common than acidosis?
Metabolic alkalosis is less common than acidosis and typically less problematic.
149
What causes metabolic alkalosis?
Metabolic alkalosis is typically caused by loss of hydrogen ions or ingestion of bicarb/other bases.
150
What are causes of loss of hydrogen ions leading to metabolic alkalosis?
Causes include vomiting, gastric fistulas, diuretic therapy, and mineralocorticoid excess (like aldosterone).
151
How does vomiting cause metabolic alkalosis?
Repeated vomiting loses gastric acid, leaving behind a more alkalotic state.
152
How do gastric fistulas cause metabolic alkalosis?
Gastric fistulas are pathways for protons to leave the stomach and body, resulting in alkalosis.
153
What kind of diuretic therapy often causes loss of protons and metabolic alkalosis?
Diuretic therapy where the vast majority are potassium wasting.
154
How do potassium wasting diuretics reduce blood acidity?
Potassium wasting diuretics often cause loss of potassium and protons, reducing blood acidity.
155
How does mineralocorticoid excess (like aldosterone) cause metabolic alkalosis?
Aldosterone increase will excrete more potassium, which goes hand in hand with protons.
156
What other treatments can cause metabolic alkalosis?
Treatment with or overproduction of steroids that resemble aldosterone, IV bicarb (overinfusion), and ingestion of bicarb or other bases can cause metabolic alkalosis.
157
How can ingestion of bicarb or other bases cause metabolic alkalosis?
Consuming alkaline compounds like calcium carbonate or sodium bicarbonate can cause this.
158
In uncompensated respiratory acidosis, what are the typical changes in PCO2, pH, and bicarb?
Uncompensated respiratory acidosis has too much CO2, pH drops, and a slight increase in bicarb.
159
In uncompensated respiratory alkalosis, what are the typical changes in PCO2, pH, and bicarb?
Uncompensated respiratory alkalosis has too little CO2, pH increases, and a slight drop in bicarb.
160
In partially compensated respiratory acidosis, what are the typical changes in PCO2, pH, and bicarb?
Partially compensated respiratory acidosis has low pH, high PCO2, and significantly high bicarb.
161
In partially compensated respiratory alkalosis, what are the typical changes in PCO2, pH, and bicarb?
Partially compensated respiratory alkalosis has high pH, low PCO2, and significantly low bicarb.
162
In partially compensated metabolic acidosis, what are the typical changes in bicarb, pH, and PCO2?
Partially compensated metabolic acidosis has low pH, low bicarb, and significantly low PCO2.
163
In partially compensated metabolic alkalosis, what are the typical changes in bicarb, pH, and PCO2?
Partially compensated metabolic alkalosis has high pH, high bicarb, and significantly high PCO2.
164
What does the Anion Gap measure?
The Anion Gap measures the difference between measured cations and anions in the blood.
165
What principle applies to cations and anions in the blood to maintain electrical balance?
Electrical Neutrality: Cations in the blood will have to equal anions in the blood to maintain electrical neutrality.
166
Does electrical neutrality apply to charge differences across cell membranes?
No, electrical neutrality applies to the blood itself, not the charge difference across cell membranes.
167
What is the major measured cation in the blood?
Major Measured Cation is Sodium [Na+].
168
What normal value is used for [Na+]?
We are gonna use 142 mEq/L here for normal.
169
What are the major measured anions in the blood?
Major Measured Anions are [Cl-] and [HCO3-].
170
What normal value is used for [Cl-]?
Chloride will be 106 mEq/L for normal.
171
What normal value is used for [HCO3-]?
HCO3- will be 24 mEq/L for normal.
172
Using the normal values (Na=142, Cl=106, HCO3=24), what is the sum of measured anions?
Using these normal values: 106 + 24 = 130.
173
What is the normal anion gap value using the standard formula and normal values?
Anion Gap = [Na+] - ([Cl-] + [HCO3-]). Using normal values: 142 - (106 + 24) = 12 mEq/L.
174
What is the margin of error for the normal anion gap?
+/- 4 mEq/L is the margin of error.
175
Why is there a gap in the measured ions?
The gap is due to unmeasured ions, it's just an estimate.
176
What type of molecule contributes significantly to the lack of negative charges (the gap)?
The lack of negative charges is also due to proteins.
177
Which protein is mostly related to contributing to the anion gap, but what other proteins contribute?
Albumin related mostly, but any protein!
178
How do proteins accommodate protons?
Proteins can accommodate protons.
179
What is the complete electrical neutrality formula for blood?
[Na+] + [unmeasured cations] = [Cl-] + [HCO3-] + [unmeasured anions].
180
What are examples of unmeasured cations?
Unmeasured cations include K+, Ca++, Mg++, and others.
181
What are examples of unmeasured anions?
Unmeasured anions include proteins, HPO42-, H2PO4-, and more.
182
If unmeasured cations increase, how must measured cations change to maintain electrical neutrality?
If unmeasured cations increase, measured cations (like Na+) must decrease.
183
If unmeasured cations decrease, how must measured cations change to maintain electrical neutrality?
If unmeasured cations decrease, measured cations (like Na+) must increase.
184
If unmeasured anions increase, how must measured anions change to maintain electrical neutrality?
If unmeasured anions increase, measured anions (like Cl- or HCO3-) must decrease.
185
If unmeasured anions decrease, how must measured anions change to maintain electrical neutrality?
If unmeasured anions decrease, measured anions (like Cl- or HCO3-) must increase.
186
In a balanced system, how should Cl- change if HCO3- decreases?
In a balanced system, if HCO3- decreases, Cl- should probably increase to offset it.
187
In a balanced system, how should Cl- change if HCO3- increases?
If HCO3- increases, Cl- should decrease.
188
If changes in bicarb and chloride happen in the same proportion, how does this affect the anion gap?
If these changes happen in the same proportion, the anion gap is likely going to be normal.
189
What can affect the anion gap regarding changes in bicarb and chloride?
Large changes in bicarb without corresponding changes in chloride can affect the anion gap.
190
How is metabolic acidosis categorized based on its effect on the anion gap?
Metabolic acidosis can be categorized by its effect on the anion gap.
191
What often involves unmeasured anions and non-volatile acid production in metabolic acidosis?
The main problem affecting anion gap often involves unmeasured anions.
192
How do abnormal acids and poisons generally affect the anion gap?
Abnormal acids and poisons generally increase the anion gap.
193
What are causes of Metabolic Acidosis with Increased Anion Gap?
Causes include Ketone acids, Lactic acid, Ethylene glycol, Methanol, Salicylates, Ammonium Chloride, and Renal insufficiency.
194
What causes of Metabolic Acidosis with Increased Anion Gap are non-volatile acids?
Ketone acids and Lactic acid are non-volatile acids.
195
What are causes of Metabolic Acidosis with Normal Anion Gap?
Common causes include Diarrhea, Pancreatic fluid loss, Renal tubular acidosis, and Chloride retention by the kidneys.
196
What types of metabolic acidosis problems tend to maintain a normal anion gap?
These are more normal, common, less severe problems that the body can handle.
197
Are loss of bicarb and diarrhea generally severe in children compared to adults?
Loss of bicarb and diarrhea are generally not severe in adults but can be dangerous in children.
198
Why are these problems more dangerous in children?
Children have less ability to manage changes in pH and bicarb due to underdeveloped kidneys.
199
Do neonates have specific fluid management needs?
Yes, Neonates have specific fluid management needs.
200
Why can diluting infant formula be dangerous for neonates?
Diluting infant formula can be dangerous for neonates as they cannot excrete excess water effectively.
